A new survey reported in the New England Journal of Medicine reveals that the …

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The impact of computers to increase efficiency has been fairly widespread; try to imagine an architect, accountant, or administrator working without one in 2008. But some occupations seem to be holding out, and the medical profession is one of those. A new report in the New England Journal of Medicine paints a disturbing picture of just how slow adoption is.

Electronic health records (EHRs), as I found out recently while researching an article, are a byzantine and complex field, with tens of different platforms and products, both proprietary and open source. The US, unlike many other developed nations, lags behind in the widespread adoption of EHRs. Exact figures have been hard to come by in the past; numbers ranged between 9 and 20 percent among the sources I found, but those are actually overestimates, according to the NEJM report.

The researchers conducted a national survey of 2,758 physicians, a larger sample size than previous studies, and I must admit that I found the numbers a little shocking. Only 4 percent of respondents were using what was defined as an "extensive, fully functioning" EHR system, and in total, 13 percent were using a basic system. The definition of fully functioning or basic was arrived at with the help of an expert panel, and the differences can be found in the article. The survey didn't take into account physicians working in federal hospitals (including the VA, which has an EHR system that has been widely praised), Osteopaths, residents, and a number of specialties including anesthesia, psychiatry, pathology, and radiology.

Physicians who did have some form of EHR system were more likely to be young, working large practices, mostly in hospitals or health centers, located in urban areas, and mainly in the western region of the US.

When the benefits of EHRs were examined, physicians who used a fully-featured system reported more benefits over those with a basic system, but both groups reported having prevented drug allergies, dangerous drug interactions and being alerted to critical lab results. The vast majority (>88 percent) of physicians with EHRs reported being satisfied with their systems.

As for those without, they were much more likely to be older physicians, and working in much smaller practices. The most common reasons for not adopting an EHR system was cost, followed by fears of obscelensce, and finding a suitable system. Interestingly, concerns about interoperability and compatibility didn't feature at all as an impediment to adoption; this is in contrast to frequent complaints I encountered when discussing the subject with medical professionals in the past.

The authors address the disparity between previous studies and theirs, with regard to adoption numbers; using the less stringent criteria from a 2006 study that reported 9 percent uptake, their data arrived at a figure of 13 percent, which at least shows the trend line moving in the right direction. Still, there's a long way to go.